Diagnostic Facility

Tonometry

Regular glaucoma check-up in Nethradhama includes a detailed history and ocular examination.

The technique of measurement of pressure within the eye (Intra ocular pressure – IOP/IOT) is called tonometry. This is very important since IOP is one of the indicators of Glaucoma. Tonometry is recommended in everyone over the age of 40, family history of glaucoma, Myopia, Diabetes and any history of previous ocular injuries. This technique can be performed with either applanation or non-contact tonometer.

Ophthalmoscopy

Ophthalmoscopy is used to examine the inside of the eye, especially the optic nerve. In a darkened room, the doctor will examine your eye by using an ophthalmoscope (an instrument with a small light on the end). This helps the doctor look at the shape and color of the optic nerve.

If the pressure in the eye is not in the normal range, or if the optic nerve looks unusual, then one or two special glaucoma tests will be done. 3-Dimensional examination of optic disk too is done.

Visual Field Examination

HUMPHREY ZEISS VISUAL FIELD ANALYSER

The perimetry test is also called a visual field test. During this test, you will be asked to look straight ahead and then indicate when a stationary light appears in the field of vision. This helps draw a "map" of your field of vision. This is a non-invasive computerised test which takes about 10-20 minutes to perform and gives information regarding optic nerve damage due to glaucoma. In Nethradhama, we have Humphrey Zeiss Visual Field Analyser which is used for both diagnosis and follow up of Glaucoma.

GDx Pro Nerve Fiber Analyser

Nethradhama is pleased to announce that it has installed the new GDx PRO NERVE FIBER LAYER ANALYZER, first of its kind in Karnataka. This analyzer represents the latest in technology for glaucoma diagnosis and treatment.

The Nerve Fiber Analyzer will allow us to actually measure subtle changes in the health and structure of the optic nerve head. The results of this test will provide useful and important information to complement our current standard methods of diagnosing and monitoring

GDx PRO NERVE FIBER ANALYSER

your glaucoma, such as intraocular pressure measurements and visual Field testing. The GDx Pro analyzer will be used to follow the progress of glaucoma over time. The greatest value of the Nerve Fiber Analyzer may be in its ability to detect thinning of the nerve fiber layer over a period of time.This latest breakthrough in technology for management of

Glaucoma is available at Nethradhama. This tool is also very useful in those people who are branded as "borderline". This sensitive tool can help in ending the controversy thus reducing the mental and physical trauma and financial burden to patients who are being treated on suspicion without actually having glaucoma.

Glaucoma and Optic Nerve Head Digital Photography

The photographs below demonstrate various degrees of optic nerve head cupping caused by increased intraocular pressure

Normal disk photo

Early stage glaucoma

Moderate stage glaucoma

Advanced stage glaucoma

Ultrasound Biomicroscopy (UBM)

UBM provides high resolution imaging of the front portion, or anterior segment, of the eye. It is able to achieve this high resolution, on the order of 50 microns (a micron is 1/1000 of a millimeter, or 1/2500 of an inch), by the use of high frequency ultrasound transducers.

The procedure is similar to ultrasound procedures involving the heart (cardiac echography) or the examination of a baby prior to birth. The ultrasound probe is moved slowly over the surface of the eye, and images are recorded.

Structures which can be seen in the normal eye include the cornea, anterior chamber, iris, posterior chamber, ciliary body, sclera, anterior lens capsule, the end of Descemet's membrane(Schwalbe's line), and the scleral spur. The two forms of glaucoma which have benefited the most from ultrasound biomicroscopy research are angle closure glaucoma and pigment dispersion syndrome. We are proud to install this unit which is first of its kind in Karnataka.

Optical Coherence Tomography (OCT)

Optical coherence tomography is a new, noninvasive, noncontact, imaging technology capable of early detection of glaucoma through it's ability to evaluate the nerve cells damaged in glaucoma.

Glaucoma Services

Treatment Modalities

Glaucoma medication being dispensed in Suman Pharma on Doctors Prescription

Glaucoma is usually controlled with eye drops taken daily which prevent damage to the optic nerve by lowering eye pressure, either by slowing the production of aqueous fluid within the eye or by improving the flow out of the eye. Recently there have been a few new medications which show great promise for more effectively controlling eye pressure. In order for these medications to work, you must take them regularly and continuously as they are prescribed. Quite simply, the key to the success of medication therapy is patient compliance.

Yag Laser Iridotomy

If topical and/or oral therapy is not controlling the intraocular pressure (IOP), or if the patient is not taking their medicine according to schedule, laser surgery treatment may be an effective alternative or adjunct. The laser is usually used in one of two ways. In open-angle glaucoma, the laser is used to enlarge the drain (Diode laser trabeculoplasty) to help control eye pressure. In angle-closure glaucoma, the laser creates a hole in the iris (Yag Laser Iridotomy) to improve the out flow of aqueous fluid to the drain.

Yag Laser Iridotomy in Progress

Yag laser iridotomy is performed almost exclusively for patients with narrow angle glaucoma, or acute angle closure glaucoma. Yag laser iridotomy involves making a tiny opening in the iris with a laser, which allows fluid to drain freely. The laser peripheral iridotomy procedure is usually completed as a brief outpatient procedure. Prior to the procedure, the pupil is often constricted with an eye drop medication known as pilocarpine. The procedure itself is completed with the patient seated at the laser, and requires no sedation. Usually, a lens is placed on the eye after topical anesthetic drops are applied to better control the laser beam. The entire procedure only takes a few minutes. The lens is then removed from the eye, and vision will quickly return to normal. After the procedure, your eye surgeon may recommend anti-inflammatory eye drop medications for the next few days. A post-op visit will be scheduled.

Selective Laser Trabeculoplasty (SLT)

SLT uses a lower- energy laser to selectively treat pigmented cells within the drain of the eye. This is a relatively new type of Laser treatment for Open angle type of glaucoma.Intially Argon Laser was being used to the same effect.However it is now given up and SLT is the more safe and refined version of the same. The advantages of SLT is that it is a painless short procedure. Following treatment there is a modest reduction in the intraocular pressure. This may help the treating physician to withdraw one or two antiglaucoma medications being used This is especially beneficial in the subset of patients where certain antiglaucoma medications are either contraindicated or not tolerated.It is also beneficial as the first line of therapy in early glaucoma where intraocular pressure elevation is not very high.Its also useful in Ocular Hypertensives.

This procedure has almost negligible side effects. However re-treatments might sometimes be required.

Trabeculectomy

When glaucoma continues to progress despite the use of medication regimens and possibly laser treatments, a glaucoma filtration procedure (trabeculectomy) may be recommended. The goal of the glaucoma filtration procedure is to create a new passageway by which aqueous fluid from inside the eye can escape, thereby lowering the pressure.

Transscleral Cyclo Photocoagulation (TSCPC)

Transscleral cyclophotocoagulation is a procedure for glaucoma that is performed on an outpatient basis. In this procedure, the ciliary body of the eye, which creates aqueous fluid, is treated with laser to decrease production of aqueous. This in turn reduces pressure inside the eye. The technology has been available for nearly 30 years, but has only recently become available to glaucoma patients. Nethradhama takes the privilege to perform the procedure for intractable glaucoma first time in Karnataka.

Laser Deep Sclerectomy is a less invasive technique than filtering surgery that leaves the anterior chamber (front of the eye) intact and avoids creation of blebs. In deep sclerectomy, the surgeon removes a deep piece of the sclera (the white part of the eye), part of the trabecular meshwork, and the front of Schlemm's canal (the vessels that return fluid into the blood stream).

Cyclocryotherapy

In cyclocryotherapy, an extremely cold instrument (probe) is repeatedly applied to the sclera, the white part of the eye. The probe destroys the ciliary body, the part of the eye that produces fluid. Cyclocryotherapy may be used to treat severe glaucoma that has not improved after other types of treatment or surgery have been tried